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Final year Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Generate a management plan for ARDS

A
  1. Ix: Bloods: FBC, U+E, LFTs, Clotting, amylase, CRP, cultures, ABG.
  2. CXR - Bilateral perihilar infiltrates.
  3. PaO2: FiO2 <200
  4. Mx: Admit to ITU for organ support and management of underlying cause.
  5. Ventilation: indication: PaO2 <8kpa despite 60% FiO2
    PaCO2 > 6kpa
    Method: 6ml/kg + Peep.
    SEs: VILI, VAP, Weaning difficulty.
  6. Circulation: invasive BP monitoring.
    Maintain CO and DO2 with inotropes.
    e.g. NA, Dobutamine.
    7.RF : ?haemofiltration.

8: sepsis . Abx
9. INutritional support (enteral, TPN)

Prognosis: 50-75% mortality.

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2
Q

Diagnosis of ARDS

A

Acute onset
CXR: Bilateral infiltrates
No evidence of CCF
PaO2:FiO2 <200

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3
Q

Causes of ARDS

A

Pulmonary: Pneumonia, Aspiration, Inhalation injury, Contusion

Systemic: Shock, sepsis, trauma, haemorrhage + multiple transfusions, pancreatitis, acute liver failure, DIC, Obs (eclampsia, amniotic embolism)
Drugs: aspirin, heroin.

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4
Q

Respiratory Causes of clubbing

A

Resp: Carcinoma - bronchial/mesothelioma
Chronic lung suppuration - Empyema, Abscess, bronchiectasis, CF.
Fibrosis - IPF, CFA. TB

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5
Q

Pneumonia Ix

A 
BLoods: FBC, U+E, CRP, LFT, Culture, ABG 
Urine Ag (pneumococcal, legionella)
Sputum MC +S 
IMaging - CXR
Special - paired sera Abs
IF - PCP
BAL
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6
Q

CURB 65 score

A 
Confusion (AMT >8)
Urea >7
RR > 30 
BP <90/60
>65

0-1 Home tx
2 - hospital
>2 - query ITU

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7
Q

CAP Abx

A

Abx - trust guidelines
(Mild - Amoxicillin 500mg TDS PO for 5d
Mod - Amox + Clarithromycin 500mg BD PO/IV
sev - Coamox 1.2g TDS IV + Clari 500mg BD IV

Atypical -chlamydia - doxycycline
PCP - cotrimoxazole
Legionella - clari + rifampicin.

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8
Q

CAP mx

A 
Abx
o2 
Fluids
analgesia
chest physio 
consider ITU if shock, hypercapnia, Hypoxia
F/up 6 weeks CXR - underlying Ca.
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9
Q

HAP mx

A

Gram -ve enterobacteria, S.aureus.

Mild <5d - Coamoxiclav 625mg
sever > 5d Tazocin 4.5mg for 7d +/- Vanc + gent
.

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10
Q

Complications of Pneumonia

A

Respiratory failure - 02 and ventilate
Hypotension - Fluids challenge -> central line -> refractory -> inotropes.
AF - B blockers/digoxin
Pleural effusion - tap and send for MC+S, cytology and chemistry.
Empyema - (recurrent aspiration - anaerobes, staph, gram -ve) -> recurrent fevers. Tap -> turbid, LDH, ph<7.2, low glucose. Mx: US guided CHest drain and abx.

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11
Q

qSOFA

A

identifies poor outcome outside ICU.
GCS <15
RR >22
SBP<100

> 1 = 3-14x increased mortality

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12
Q

Septic shock

A

persistent hypotension (need vasopressors to maintain MAP >65 )and lactate >2.

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13
Q

Atypical pneumonias

A

S.aureus - Influenza, comorb, IVDU - > bilateral CAVITATING bronchopneumonia. Tx: Fluclox, VAnc

Klebsiella - Rare, elderly, etoh, DM -> cavitating pneumonia upper lobes. -> cefotaxime.

pseudomonas - bronchiectasis/CF -> Taz

Mycoplasma - Epidemics - Dry cough, reticulonodularshadowing, patchy cons, FLu prodrome, headache, myalgia -> cold agglutinins AIHA, Cryoglobuin, erythema multiforme, SJS, GBS, Hepatitis,
Dx: serology. Tx ; Clarithromycin, ciprofloxacin.

Legionella: Travel/aircon -> dry cough, sob, bi basal cons. -> flu prodrome, anorexia, d+V, hepatitis, renal failure, confusion, SIADH -> hyponatremia.
Deranged LFTs, lymphopenia. Dx: Urinary Ag, serology.
tx: clari, rifampicin.

Chlamydia pneum: Pharyngitis, Otitis -> pneumonia. Sinus pain. dx. serology, clarithromycin.
Chlam psittaci: parrots, dry cough, patchy cons, -> Horders spots, rose spots, splenomegaly, epistaxis, hepatitis, nephritis, meningoencephalitis -> Serology, Clari

PCP: iC. Dry cough, SOBOE, Bilateral creps. CXR: normal or bilateral perihilar interstitial shadowing.
DX: Visualisation from BAL. sputum. biopsy.
tx: high dose Co-trimoxazole or pentamidine.

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14
Q

Types of venturi mask

A 
Blue: 24% 2L
White: 28% 4L 
Orange: 31% 6L
Yellow: 35% 8L
Red: 40% 10L
green: 60% 15L
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15
Q

Asthma definition

Incidence

A

Episodic reversible airway obstruction due to bronchial hyperreactivity to a variety of stimuli.
5-8%

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16
Q

dx asthma

A

spirometry: Obstructive pattern
>15% bronchodilator reversibility.
PEFR monitoring: diurnal variation > 20%
morning dipping.

17
Q

General measures in Management of chronic asthma

A

General Measures (TAME)

Technique for inhaler use
Avoid triggers (smoke, pollen)
Monitoring (PEFR diary2-4x a day)
Educate ( liasie with nurse sp., need for compliance, emergency action plan).

18
Q

Asthma Mx

A
  1. Low dose ICS/formoterol prn
  2. Low dose ICS daily beclometasone 100-400ug bd
  3. Low dose ICS + LTRA
  4. Low dose ICS laba salmeterol 50ug bd (MART)
  5. Med dose ICS laba increase steroid to 400
  6. High dose ICS laba +/- Lama 1000ug
    theophylline.
  7. OCS
19
Q

PE ecg changes

A 
Sinus tachycardia
Deep S waves lead 1, Q waves lead 3, TWI in lead 3
RV strain
RAD
AF
20
Q

Multiple ill defined opacities on CXR ddx

A 
Pulm mets
pulmonary infarcts
Rheumatoid 
GPA
Septic emboli
21
Q

Aspergillus 5 effects on lung

A

Asthma - Type 1 hypersensitivity
Allergic bronchopulmonary aspergillosis - type 1 and 3 hypersensitivity - w recurrent asthma, bronchial damage, bronchiectasis. + aspergillusskin test, raised IgE, eosinophilia, serum precipitins.

Mycetoma - fungus ball in pre existing lung cavity

Invasive aspergillosis - Immunosuppressed (high mortality)

Extrinsic allergic alveolitis - recurrent SOB, dry cough -> fibrosis

22
Q

Causes of cavitating mass CXR

A 
bronchocarcinoma
Sq Cell carcinoma mets
Pulmonary infarct
Wegeners granulomatosis
Bacterial lung abscess
Mycetoma.
23
Q

Causes of PTX

A 
Asthma
Marfans
COPD
Ventilation
Rib fracture
Central line insertion
24
Q

Upper lobe Lobar collapse CXR changes

A

Soft tissue density with well defined lateral border
Loss of clarity of mediastinal border.
S-sign of Golden=bulge (tumour) in collapsed lobe.

25
Q

Superior vena cava syndrome

A

Obstruction of blood flow through SVC.
Asymptomatic -> head and neck oedema.
arm swelling, vision change, nasal stuffiness, nausea, light headedness.

O/E: Venous distension of neck + chest wall. facial oedema. upper extremity oedema. mental changes. plethora. cyanosis. papilloedema. stupor, coma.

26
Q

causes SVC syndrome

A

Causes: mostly bronchogenic carcinoma. Lymphoma. Thrombosis secondary to pacing wires/CV catheters.

27
Q

Mx SVC syndrome

A

Elevate head of bed.
Oxygen.
Steroids - releive laryngeal/cerebral oedema.
Surgical bypass/stenting.

28
Q

Complications of SVCsyndrome

A

Stridor
COnfusion
Circulatory failure.

29
Q

Causes of consolidation

A

Aspiration
Pneumonia
Haemorrhage

30
Q

Granulomatous disease differentials

A

Infections: TB, Leprosy, syphilis, crypto, shisto,
AI: PBC
Vasculitis: GCA, PAN, wegeners, Takayasus
Idiopathic: crohns, sarcoid.
ILD: EAA, silicosis.

31
Q

causes erythema nodosum

A

Infections: strep, TB, mycoplasma, yersinia, psittacosis, salmonella, c. jej. histioplasmosi, blastomycosis, coccidomycosis

Sarcoid

IBD

leukaemia, Hogkins

Drugs - sulfonamides, OCP
Pregnancy

32
Q

Causes lobar collapse

A

asthma - Mucus plug
Tumour
bronchiectasis
foreign body -child.

Final year Medicine (18 decks)

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